Khazaaleh Shrouq, Gonzalez Adalberto J, Alomari Mohammad, Wadhwa Vaibhav, Shah Bhavan, Shen Bo
Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA.
Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, USA.
Cureus. 2022 Jun 19;14(6):e26076. doi: 10.7759/cureus.26076. eCollection 2022 Jun.
Clostridium difficile infection (CDI) is an anaerobic infection that can carry detrimental outcomes for patients and is a growing burden to the US healthcare system. Various theories have been proposed for the etiopathogenesis of CDI, including antibiotic use, dysbiosis, and acid suppression. The role of ischemia in CDI has not been explored. We hypothesize that tissue ischemia is a risk factor for the development of CDI. The study aimed to assess whether ischemia was a risk factor for CDI using ischemic colitis as a target population.
We performed a case-control study using the National Inpatient Sample (NIS) database in 2013. The study group included all patients with ischemic colitis (ICD 9 Code: 557.0, 557.1, 557.9) and the control group included all patients with diverticulitis (ICD 9 Code: 562.11, 562.13). Univariable and multivariable analyses were performed to assess the risk factors associated with CDI (ICD 9 Code: 008.45). The case and control groups were compared using the chi-square test for analysis. Continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. In addition, multivariable logistic regression analysis was performed to assess the association between disease group and CDI while adjusting for confounders. Univariable analysis was performed to assess differences between subjects with ischemic colitis and those with diverticulitis; continuous variables were compared using t-tests and categorical variables were compared using Rao-Scott chi-square tests. All analyses were done using SAS (version 9.4, The SAS Institute, Cary, NC).
We analyzed more than 30 million hospitalizations in 2013, with 120,490 being Ischemic colitis-related admissions and 309,940 being diverticulitis-related admissions. The rate of CDI was more in the ischemic colitis group than in the diverticulitis group (odds ratio [OR] = 1.39; 95% confidence interval [CI] [1.03-1.88], p=0.03). After adjusting for all variables, multivariate analysis showed CDI was associated with ischemic colitis (OR = 2.06; 95% CI 1.59-2.65, p<0.001).
CDI was shown to be more prevalent in ischemic colitis than in diverticulitis control in this population-based study. As C. difficile is an anaerobe, we hypothesize that tissue hypoxia is a risk factor for its development. Further studies are needed to validate our findings.
艰难梭菌感染（CDI）是一种厌氧菌感染，会给患者带来不良后果，且给美国医疗系统造成日益沉重的负担。关于CDI的病因病机已提出各种理论，包括抗生素使用、生态失调和抑酸作用。缺血在CDI中的作用尚未得到探讨。我们假设组织缺血是CDI发生的一个危险因素。本研究旨在以缺血性结肠炎为目标人群，评估缺血是否为CDI的危险因素。
我们使用2013年国家住院患者样本（NIS）数据库进行了一项病例对照研究。研究组包括所有缺血性结肠炎患者（国际疾病分类第九版编码：557.0、557.1、557.9），对照组包括所有憩室炎患者（国际疾病分类第九版编码：562.11、562.13）。进行单变量和多变量分析以评估与CDI（国际疾病分类第九版编码：008.45）相关的危险因素。使用卡方检验对病例组和对照组进行分析比较。连续变量使用t检验进行比较，分类变量使用Rao-Scott卡方检验进行比较。此外，进行多变量逻辑回归分析以评估疾病组与CDI之间的关联，同时对混杂因素进行校正。进行单变量分析以评估缺血性结肠炎患者与憩室炎患者之间的差异；连续变量使用t检验进行比较，分类变量使用Rao-Scott卡方检验进行比较。所有分析均使用SAS（版本9.4，SAS研究所，北卡罗来纳州卡里）完成。
我们分析了2013年超过3000万次住院病例，其中120490例为与缺血性结肠炎相关的入院病例，309940例为与憩室炎相关的入院病例。缺血性结肠炎组的CDI发生率高于憩室炎组（优势比[OR]=1.39；95%置信区间[CI][1.03 - 1.88]，p = 0.03）。在对所有变量进行校正后，多变量分析显示CDI与缺血性结肠炎相关（OR = 2.06；95% CI 1.59 - 2.65，p < 0.001）。
在这项基于人群的研究中，CDI在缺血性结肠炎中比在憩室炎对照组中更为普遍。由于艰难梭菌是厌氧菌，我们假设组织缺氧是其发生的一个危险因素。需要进一步研究来验证我们的发现。
